Tales from the Field - Part 1

Tales From the Field #1

By Betsy Freeman

I am two months into my six-month mission in northern Nigeria.  My world here is small:  base, hospital, base.  I walk the path between them several times a day.  At night our beat up Land Rover shuttles me back and forth bleary eyed.  We work six days a week and I'm on call for two nights as well.  Most calls I'm at the hospital for most of the night. 

Our two main services here are emergency obstetrics and obstetric fistula repair.  I spend my days and nights supervising the local midwives and managing the emergencies that come through the door. I have to step back from the experience from time to time.

It is, in a word, mind-blowing.  Here’s a snapshot....

Last night I’m on call after working my usual day shift.  I get called in around 11pm because there is an eclamptic patient who has blood pressures of 220/140, already being treated with magnesium sulfate.  We give her hydralazine to bring the pressure down.  She is fully dilated but comatose so we do a vacuum delivery with fundal pressure to get the baby out.  As we are doing this delivery, I watch as the patient beside her, a postpartum eclamptic also starts seizing, also already on magnesium.  We turn to her for five minutes push more mag, then the other one has a full on postpartum hemorrhage.  We get both of them stabilized and I leave the hospital for about 30 minutes.  Just as I'm turning off the light to go to bed, they call me back in.

This time I arrive to a woman sitting up in bed in respiratory distress.  She is sweating, incredibly anxious, and has a hemoglobin of 1.7; she's in pulmonary edema.  Her oxygen saturation is 50% on oxygen.  We give her lasix, blood, then more lasix.  We roll her to our ICU, which is essentially a room very similar just down the hall.  She lies next to the woman who is status post uterine rupture and hysterectomy and the postpartum para 16 (that’s 16 pregnancies!) who has malaria and typhoid and a suspicious chest infection.  I'm home by 2am and have dreams all night about triage.

Today, back on the floor, two more fresh eclamptics, (plus the one who seized on mag who looks like she's suffered from hypoxia), one which is six to seven months pregnant who is being induced, an intrauterine fetal demise x 2 months that we're also inducing, another pre-eclamptic we're trying to induce but who appears psychotic and is refusing to be examined.  We can’t control the pressures of the eclamptic who is preterm so opt for cesarean.  We are dooming her to a life of subsequent c-sections for a baby that won’t survive, but it’s the only option left if we want to save her. 

And the list goes on and on and on, every day, into the night and into the next day.  It is truly some of the most exhausting work I've ever done.  We've had twelve maternal deaths in six weeks so the emotional part is equally as exhausting.  I'm learning a lot and definitely feel our need to be here.  The people of northern Nigeria are kind and incredibly grateful.  The woman with the hemoglobin of 1.7 (now 5) raised her hands up to me in thanks this morning when I came to see her.  It's moments like these when it all feels worth it.

To read all "Tales from the Field" click here. 

About Betsy

Betsy has spent a significant portion of her life working as a midwife and humanitarian.  After graduating from Emory University, Betsy served two years as a Peace Corps volunteer in Mauritania, West Africa.  Here she witnessed birth for the first time and felt immediately drawn to a career in midwifery.  Betsy returned to pursue a master’s degree at Columbia University in New York City.  She spent the next eight years working as a midwife in public hospitals around the city, taking care of uninsured women and delivering hundreds of babies.  Although her patients were primarily recent immigrants from countries around the world, she still felt the pull to return overseas.  Following the devastating Haiti earthquake in 2010, Betsy volunteered on several missions to Port-au-Prince, assisting women and families in the wake of this natural disaster.  Later that year she spent six months in Democratic Republic of Congo and Central African Republic working alongside and training midwives in these war torn countries.  Currently on mission in Nigeria, Betsy continues to try and help women give birth safely. At a time when maternal health care has finally captured the world’s attention, Betsy hopes to further awareness of this critical issue by speaking candidly about her experiences directly from the field.